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43 Cards in this Set
- Front
- Back
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What 2 electrolyte abnormality causes hyperactive deep tendon reflexes? |
Hypocalcemia, hypomagnesemia |
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Electrolyte disturbance after surgery w/ transfusions? Why? sx? |
hypocalcemia hypoalbuminemia and volume expansion hyperactive DTRs, muscle cramps, convulsions |
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Electrolyte disorder from prolonged NGT? Sx? Other things that cause this? |
Hypomagnesemia -hyperactive DTRS, muscle cramps -alcholism, diarrhea, diuretic use |
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EKG w/ narrow QRS, different P wave morphologies, variable PR segments, and RR intervals = ? Causes? 1st step? TMT? |
Multifocal Atrial Tach (MAT) = 3 or more P waves -hypoxia, COPD, emphysemia, CHF, meds (theophylline, isoproteronlo), hypoK, hypoMg -check O2 sat -Treat underlying problem, Give Oxygen first, then diltiazem, |
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patient worryig about random symptoms, everything normal = ? Dx reqs? How manage? |
Somatic Sypmtom disorder - >1somatic sx for >6mos causing social/occupation impairment -arrange regular visits (monthly)w/ one physician to gain rapport |
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Pt w/ discrete smooth circular area hair loss scalp (no scaling or inflammation)? will it regrow? Cause? Will it happen again? -tmt? |
Alopecia Areata -yes -unclear, autoimmune T-cell infiltration hair folllicles associated with other autoimmune -yes, in 1/3 pts -intralesional corticosteroid |
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Patient has multiple syncopal events associated with emotional stressors? next test? |
vasovagal syncope -none |
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patient w/ hgb 19 - problem? most likely cause? best initial test? dx based on results? |
polycythemia (>16.5 female or 18.5 male) -chronic hypoxia from heart or lung dz(smoker) -first rpt, then serum eyrthopoietin level -if high ->chronic hypoxia (check nocturnal O2 sat and carboxyhemoglovin levels), extra hi - > tumor secretion like RCC, low->polycythemia vera (chronic myeloproliferative disorder) |
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Patient with chronic headache - 1st dx step? headache occurs multiple times daily lasting 30min to 3 hours, one side, retrooribtal, conjuctival injection, rhinorrhea, sweating, over one month =? Preventative tmt? Acute tmt? |
headache diary for one week -Cluster headache (can have horner sx) -Verapamil (can titrate up to 4 times over starting dose, but check EKG b4 to r/o heart block or brady) -100% O2 |
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band-like headache = ? |
tension headache |
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Effects of warfarin in pregnancy? What to do about anticoag in pregnancy? Breastmilk? |
Teratogenic (nasal and limb hypoplasia, fetal bleedng) -switch to LMWH for 1st trimester and few weeks before delivery (stop all anticoagulation at onset labor) -warfarin doesn't go to breastmilk |
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Patient with normal TSH, High T4, low T3, w/ palpitations, paroxysmal Afib last 3 months, on atenolol, amiodarone, aspirin -Cause? -How? -next step |
Amiodarone induced thyroid dysfunction (hi iodine content) -3 mechs: slows peripheral conversion T4 to T3, inhibitis thyroid hormonse synthesis, thyrotoxicosis w/ hi thyroid hromone and low T4 -rpt thyroid levles in few weeks (levels normalize after 3 months tmt) |
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Steps to diagnosing dementia? TMT? |
-r/o thyroid, B12 deficiency -Acetylcholinesterase inhibitor (donepezile/ Tacrine) |
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Pt with intrauterine preganancy with crescent-shaped hypoechoic area suggestive hematoma raound gestational sac = ? Next step? most likely complication? |
Subchorionic hematoma -rpt u/s in one week (no therapeutic intervention) -spont abortion |
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How long does it take for viral load to decrease <200 when starting HAART? |
6 months (logarithmic drop) |
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Tetanus rules: clean/minor wound w/ >=3tetanus toxoid doses? Clean/minor wound w/ uncertain or <3? Dirty/severe wound w/ >=3 tet toxoid doses? dirty/severe wound w/ uncertain or <3? How often regularly get tet toxoid vaccine? |
-tet Toxoid vaccine only if last dose >=10 yrs ago -tet toxoid vaccine only -tet toxoid vaccine only if given >=5yrs ago -tet toxoid PLUS Tet immunoglobulin (TIG)=provides passive immediate temporary immunity -every 10 years |
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Patient walks with slow speed, barely raises feet, small steps, appears hesitant and "freezes" when approaching objects = what sx? -most likely dx? |
-Shuffling Gait -Parkinsons |
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Describe senile gait of aging? Spastic pararesis gait? Gait in cerebellar ataxia? Gait in distal lower motor neuron dz? |
-walking on ice, feet wide apart like expect to fall down, cautious gait -"scissoring gait" circular leg moovements dragging legs forward each step, no knee flexion -"drunken sailor gait", jerky, zigzag, irregular -steppage gait with foot drop and excess elevation legs |
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Patient with SLE w/ cardiac arrest in ED after having substernal chest pain. Why? What other increased risks do they have? |
-50-fold increased risk premature CAD(atheosclerosis) -pericarditis, non-hodgkin large B cell (rapidly enlarging mass neck or abdomen present wth airway compromise) |
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Pt w/ h/o HTN, HLD, recent URI presents with bilateral pedal edema, fatigue, Cr 5.2 (baseline 1.2), U/A w/ 4+ptn, 0RBC, 20WBC, few granular casts Most likely cause? why not others/ |
-Analgesic induced nephropathy (when have nephrotic range ptnuria, NSAIDS cause reversible decrease renal blood flow and GFR from inhibit vasodilatory prostaglandin) -Not poststrep glomerulonephritis since no blood in u/a -not uncontrolled HTN since takes years |
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Pt w/ joint pain/swelling <=4 joints Workup? |
Joint aspiration-if inflammatory (>2000wbc, 75% PMN)->crystal = gout vs pseudogout, ->+culture = infectious, ->sterile = RA vs. lyme vs SLE vs sarcoid vs. spondylarthropathy |
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Patient w/ R knee and ankle pain 2 weeks, bilateral eye pain, blurry vision, burning n urination, had diarrhea a month ago from restaurant, tener swollen R knee = ? Other findings? Associated marker? Most likely findings on joint? TMT? |
Reactive Arthritis/Reiters=ASYMMETRIC arthritis, h/o urethritis or GI infxn (chlamydia vs. salmonella/shigella/yersinia/campy), uveitis/conjunctivitis, Keratoderma blenorrhagicum (skin peeling feet/dry), circinate balanitis (genital lesion head penis), achilles enthesitis (pain at ligament/tendon insertion site), sacroiliac joint involvement -HLA B27 (only seen in 20% patients) -elevated WBC in synovial fluid, NEGATIVE bacterial cx -NSAIDS |
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36yo M has back stiffness, worse at night, diminished chest expansion = ? Dx test? other findings? TMT? |
Ankylosing Spondylitis -MRI of SI joint (more sensative than XR) -kyphosis, pain worse at night relieved by leaning forward, uveitis, restrictive lung dz, aortitis (rarely) -NSAIDS, infliximab or adalimumab, sulfasalazine (NOT STEROIDS) |
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Pt with h/o scaly lesions knee, low back pain, sausage shape digits =? Other findings? Dx test? TMT? |
Psoriatic Arthritis -sacroiliitis, h/o psoriasis, nail pitting, DIP involvmeent, dactylitis (sausage fingers), enthesitis (tenderness at tendon insertion sites) -No Dx test -NSAIDS first, methotrexate if resistant, infliximab last |
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Pt w/ enlarged liver, feber, salmon colored rash, multiple painful joints =? Other findings? Dx test? TMT? |
Juvenile Rheum Arthritis (adult onset Still's dz) -fever, salmon color rash, polyarthritis, lymphaden, hepatosplenomeg, elevated LFTs, -none, hi ferritin, elevated WBC, negative RA and ANA (have to get to r/o SLE) -NSAIDS, steroids if fail |
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When to give HPV vaccine? Different vaccines to types? Patient is already sexually active = do what? Patient had HPV = do what? Patient has hypersensitivity to yeast = do what? Patient is pregnant = do what? |
9-26yr , start 11-12, 3 doses in 6 months(but can always start where you left off) Types 6,11 = genital warts, 16,18=anogen cancer (higher number = ca) -bivalent vaccine = against 16/18 -quadva=against all -9 valent = all + 5 more -can give -can give -contraindicated -contraindicated |
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Patient unconscious, irrigate R ear canal w/ cold water causes slow R deviation w/ saccadic correction midline = ? |
Psychogenic Coma (all other coma / true causes will suppress caloric response since it cannot be voluntarily suppressed) |
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What type of heredity goes via mother to offspring? |
Mitochondrial |
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Patient w/ multiple hand lesions scaly pink/white/gray spots slowly increasing in size, spends time at beach = ? Increased risk? TMT? |
Actinic Keratosis -squamous cell carcinoma -individual lesions = liquid nitrogen/cryosurgery or curretage -field therapy (5-FU cream, topical diclofenac, imiquimod ) if numerous |
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27yo M w/ several days joint pain one joint, smokes, does marijuana, sex active w/ 2 partners, condoms occasionally, joint swollen w/ limited ROM, arthrocentesis shows turbid yellow fluid = MLDx? -best test to confirm? -other common findings? |
Gonococcal Arthritis (think of it in patients with mono or oligo arthritis young w/ unprotected sex) -culture joint fluid/rectum/urethra/oral cavity -tenosynovitis (painful tendons ankle/toe joints), pustular or vesicular skin rash transient |
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irregular shaped areas of hair loss =? |
trichotillomania =psych impus control dz |
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Patient being treated for MRSA from central line infxn begins complaining of severe low back pain Next step? Most likely cause? |
MRI lumbosacral spine -vertebral osteomyelitis vs. diskitis (common in MRSA from line infxn) - may need f/u CT guided bx to confirm that lesion is infected |
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Patient w/ fever, hypotn, swelling, erythema leg w/ very painful palpation more than expected = ? Most common organism? What if crepitus? Tmt? |
Nec Fasc -Group A strep pyogenes -then closridium perfringens or b fragilis -immediate surgery, debridement, resusc, broad spec abx (pip/taz vs. carbopenem for GAS, vanco for mrsa, clinda for strep/staph toxin) |
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Name how to score probability of HIT? Cause? First step if suspected? How long off heparin? |
Heparin-induced thrombocytopenia 4Ts = thrombocytopenia (plt drop >50%=2pt, 30-50% =1), timing (5-10day=2, after 10=1), thrombosis (skin necrosis, systemic rxn=2, rando skin lesions=1), other (none=2, possible =1), 6-8 = hi probability -caused by immune mediated antibodys to platelet factor 4 (PF4) -Stop heparin and start direct thrombin inhibitor (not warfarin)=argatroban or bivalirudin -off for life |
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67yo F presents w/ severe weakness, nonbloody diarrhea. H/o controlled DM2, asthma, smoker, on glyburide, metformin, albuterol, Cr 2.5 (baseline 1.7), Na 142, K 4.5, bicarb 12, Chloride 105, Amylase 80 Next Step? Most likely Dx? |
-administer IVF, check ketones, lactate, ABG -High Anion Gap Metab Acidosis (Na-(Cl+bicarb) 10-14) MUDPILES (methanol, uremia, DKA, paraldehdye, isoniazid/iron, lactic acidosis, ethylene glycol/antifreeze, salicylates/aspirin), metformin can cause diarrhea and lactic acid buildup |
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21yo F pregnant 30wks w/ bp 150/95, enlarged liver, 2+edema, HR 100, plt 50000, schistocytes on blood smeer, u/a w/ 2+ptn, AST/ALT elevated = ? -first step? -BP medication? -differentiate from other htn preg dz |
HELLP (hemolytic anemia, elevated LFTs, low plt) -mag sulfate (prevent seizure -dont treat preg htn unless >160/100 (decrease utero placental blood flow) -Chronic HTN if b4 preg or b4 20wks = >140/90, gestational HTN if after 20 wks, preeclampsia if proteinuria and/or warning signs (vision change, edema, HA, epigastric pain), w/ HTN (if ptn 1-2+ or 500mg in 24hr urine -MILD) (if ptn 3-4+ or 5g in 24hr w/ BP >160/110= severe) -treat BP >160/100 with methyldopa or labetalol, nifedipine 2nd line (hydralazine or labetalol if acutely high) |
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tmt of substernal chest pain, ekg sinus tach, just took cocain prior? What if hypertensive? |
-IV lorazepam (benzo tto decrease anxity and agitation as chest pain may be neuropsych effects) -IV phentolamine (alternative are nitro, nitroprusside) |
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Management of anti-epileptics during pregnancy |
Dont change antiepileptic drugs for pregnancy except for valproate (should change prior). However, dont change any DURING pregnancy. Start folate supplement. Early detect fetal anomalies w/ alpha fetoprotein screening, u/s, or amniocentesis. Can breastfeed on drugs (may cause baby to be a little sleepy or irritable but thats it) |
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TMT c.diff? If recurs? |
if mild (wbc<15, cr<1.5x baseline)->po flagyl if sever (>15, >1.5x, albumin <2.5)->po vanco (add iv flagyl and do rectal vanco if ileus) if toxic megacolon/severe ileus/lactate>2.2->subtotal colectomy -same tmt if recurs, pulse taper po vanco x6-7wks if 2nd recurrence, transplant on 3rd or more |
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Patient w/ excessive sleepiness, sudden falling asleep=? First Dx step? Best initial tmt? |
Narcolepsy (napping mult times in same day, cataplexy, rapid eye movement sleep latency) -sleep study -Modafinil (daytime simulant) -if cataplexy ->start SNRI/SSRI (venlafaxine) |
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Initial tmt for Raynaud Phenomenon? What if sx don't improve w/ tmt and have joint pain |
-calcium channel blockers (nifedipine/amlodipine) or diltiazem -Check ANA and RF (since suggestive of sysemic dz and Raynoud can be associated with other connective tissue dz) |
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Most important tmt to reduce carpal tunnel sx? |
occupational rehab (special keyboards don't help) |
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Name drugs that induce pancreatitis? |
1. diuretics-furosemide/thiazide 2. IBD tmt-sulfasalazine, 5-ASA 3. immunosuppresive-azathioprine, L-asparaginase 4. seizure/bipolar tmt - valproate 5. AIDS tmt- didanosine/pentamidine 6. Abx - flagyl/tetracyclines |
